What is an Endovascular Aneurysm Repair?

An endovascular stent graft repair is a treatment for aneurysms of the descending (thoracic and abdominal) aorta. It is similar to the approach used for a cardiac catheterization of the coronary arteries. This procedure requires only small incisions in the groin. Then the surgeon inserts a catheter through the femoral artery in the groin and with the use of x-ray guidance and specially-designed instruments, the aneurysm can be repaired from inside the aorta by inserting a tube, called a stent-graft. This is possible because the tube, or stent graft, is delivered through the catheter in a collapsed state and then expanded at the site of the aneurysm.

Endovascular repair of a descending aortic aneurysm.

The tube replaces and reinforces the diseased aortic wall, ensuring continuity of blood flow while preventing further expansion of the aorta, aortic rupture, and/or aortic dissection.

The potential benefits of the procedure include greatly reduced risk, a shorter hospital stay, and a more rapid recovery.

What is a Hybrid Aortic Procedure?

Not all aneurysms can be repaired by means of endovascular stenting alone. Hybrid procedures use endovascular stenting along with open heart surgery to take advantage of the benefits of each while minimizing the limitations and related risks. Often, hybrid procedures can be custom designed for the patient in an effort to decrease size of the incision, duration of the procedure, and avoid the need to stop blood flow to the heart and/or brain. This is intended to improve recovery and ensure the best possible outcome for the patient.

Another example of a two-stage approach is the use of the minimally invasive endovascular technique, which greatly minimizes hepatic, intestinal and renal ischemia-reperfusion injury while effectively repairing this complex aortic aneurysm. This case illustrates the unique expertise afforded by the UCCAD team in dealing with straightforward as well as complex aortic pathology in proximity to or involving the aortic branches.

The images to the left depict the aneurysm before and after intervention of a 68-year-old male found to have a large 6 cm dumbbell-shaped aortic aneurysm involving the celiac, superior mesenteric and renal arteries (Figure 1, prior to repair). The aortic aneurysm was treated using a two-stage strategy. First, the visceral vessels blood supply was rerouted via a bypass with four limbs from the common iliac artery, thereby debranching the aneurysm. This prepared the aortic aneurysm for eventual exclusion with stent grafting from the distal thoracic aorta to the iliac artery (Figure 2, following repair). The patient had an uncomplicated recovery and quickly returned to his usual daily activities.

Hybrid repair with debranching of the mesenterica vessels and endovascular stent graft for an descending aortic aneurysm